1921 Archives of Internal Medicine  
Diseases of the nervous system form a somewhat obscure branch of medical science. Our ignorance of the morbid anatomy and histology of many of them is profound. It is, accordingly, a matter of no surprise that our classification of these diseases is unsatisfactory. The intimate correlation between nervous and muscular systems is recognized in the fact that under nervous diseases, every textbook includes descriptions of conditions which are, so far as known, essentially muscular. There is a
more » ... ncy to segregate those cases which show muscular atrophy into two clinical groups, the atrophies and the dystrophies. The distinction is probably not well grounded, in respect to etiology. In view, however, of our lack of knowledge of the cause of most of the nueuromusclar diseases, even this criticism must be made somewhat tentative. We can recognize the grosser causes of lack of function of the central nervous system, such as cerebral hemorrhage, or an attack of meningitis, but we know very little of the factors which maintain the central nervous system as a going concern ; even in the case of the much simpler muscular system there are many unsolved conundrums. Why is creatin always present in muscle? Does it originate in muscle or is it carried from the outside? What mechanism in the muscle transforms it into creatinin, and what is the value of this apparently essential substance in the muscular economy? With the nervous element in the neuromuscular complex remaining shrouded in mystery, there is little cause for wonder that such comparatively common conditions as disseminated sclerosis, progressive muscular atrophy, or pseudohypertrophic paralysis, remain unexplained. The essence of scientific experiment is to vary one factor at a time, the others remaining constant. In the case of the human sub¬ ject, it is difficult, almost impossible, to predicate these conditions, but an approximation to them in which there-is one outstanding clin¬ ical variation from normal and along with it one outstanding chem¬ ical variation from normal has come under notice. In the belief that it is a valuable case I venture to place it on record. REPORT OF CASE R. W. T., aged 26, single, bank clerk, consulted me Sept. 25, 1917, because of his inability to perform any unusual exertion, or, in fact, anything more than a comparatively small muscular effort would accomplish. There was no history of tiring easily; provided, the muscular work called for was small in Downloaded From: by a Monash University Library User on 06/16/2015
doi:10.1001/archinte.1921.00100090075005 fatcat:nazad37s5fh4zpaswfjduhtoxa